Thursday, February 20, 2014

Learning to Cut the Sugar

Dr. Robert Lustig became widely known as “the anti-sugar guy” after a lecture of his called “Sugar: The Bitter Truth” was posted on YouTube and gained widespread attention. In his talk, Dr. Lustig explains why all calories are not created equal, and why he believes those from sugar in particular are driving an epidemic of obesity and chronic disease.

But Dr. Lustig, a pediatric endocrinologist who runs a weight management clinic for children and families at the University of California, San Francisco, says that “anti-processed food guy” would be a more appropriate nickname, since sugar — while his biggest concern — is just one of a number of ills he sees in the modern American diet. I recently sat down with Dr. Lustig to talk about his newest book, “The Fat Chance Cookbook,” which he wrote with his friend Cindy Gershen, a chef, as a follow-up to his 2012 bestseller “Fat Chance.” Every recipe was vetted by students at Mount Diablo High School in Concord, Calif., where Ms. Gershen teaches healthy cooking.

To find out more about how children (and their parents) can learn to eat better, why sugar is not banned from his cookbook and why polenta patties are, hands down, Dr. Lustig’s favorite recipe in the book, read our edited conversation.

Q.

Your lecture on sugar spread quickly and was viewed by millions of people. Were you surprised?

A.

It blows my mind. I didn’t think anyone was going to watch it. I didn’t even know it was being taped. If I had, I would’ve worn a better tie.

Q.

A lot of studies lately have extolled the health benefits of the Mediterranean diet. Do you favor one diet or cuisine over another?

A.

I don’t have any money on any specific cuisine or diet. I think they could all work, and they all did work at one time. But now they don’t because they’re processed.

Pioppi, Italy, is where the Mediterranean diet was centered. Did they have pasta? No. It was meat and vegetables, and some red wine and olive oil. The bottom line is every country has its cuisine, and every cuisine works for that country. But there’s one thing that doesn’t work for any country: processed food. And any country that adopts processed food, which is now everywhere, is getting sick. This is why I want to be known as the anti-processed food guy, not the anti-sugar guy.

Q.

What are your thoughts on diets that focus on calories?

A.

I’m not against reducing calories. But if that’s all you’re doing, it can’t work. It depends what those calories are. Everything that comes in a 100-calorie container, half of it is sugar, whether it’s yogurt, or cookies, or whatever. If a calorie is a calorie, then it should work. But it doesn’t, because a calorie is not a calorie. And this is the thing that we have to get past. That’s why I wrote the cookbook. Because the question is, once you realize that all calories are not the same, what do you do?

Q.

You treat many obese children in your clinic. Do you ever end up treating parents as well?

A.

Almost always, we see an obese kid come in with an obese parent. And when the kid loses weight, the parent loses weight, because the parent actually changed what’s going on in the home. They made the home safe for the kid and safe for themselves as well. But if the parent is hooked on sugar and they won’t get it out of the house, then the kid can’t get better. If a parent says, ‘Oh, it’s my kid’s problem, but I’m going to eat the cookies,’ then nobody gets better. We see a lot of that.

Q.

How do you change behavior?

A.

We do one thing at our clinic that nobody else does, and it’s the key to our success. We do something called “the teaching breakfast.” Every kid comes in fasting because we’re drawing blood. So they’re all hungry. They go to the teaching breakfast with their parents – it’s six families all at a communal table – and our dietitian spends an hour with them. The dietitian narrates exactly what’s on the table and teaches the parent and the kid at the same time.

We make sure four things happen. No. 1, we show the parent the kid will eat the food. No. 2, we show the parent that they will eat the food. No. 3, we show the parent that other kids will eat the food, because they have other kids at home and they have to be able to buy stuff that they know other kids will eat. And No. 4, we show them the grocery bill, so they see that they can afford the food. If you don’t do all four of those, they won’t change.

Q.

What are the foods you put on the table?

A.

We tell them that they can make things like steel cut oats and eggs. And on the table we’ll have whole grain muffins, whole grain breads, cheeses. And we have plain yogurt with real fruit mixed in, not the standard American flavored yogurt, which is super high in sugar. And we say, ‘Look, breakfast is not the time for your sugar fix. The more sugar you eat at breakfast, the more trouble you’re going to be in.’ Sugar is the one thing you need to get out of your breakfast.

Q.

So these foods on the table are not what these children are used to eating?

A.

If you get your breakfast through the national school breakfast program, which 25 percent of school kids do, guess what you’re getting: a bowl of Fruit Loops and an eight-ounce glass of orange juice. That’s 11 teaspoons of added sugar. This is what we have to fix. But it costs money to fix, and no one wants to do that. So as a country we’re spending it on the tail end, on diabetes, heart disease and everything else.

Q.

A lot of the recipes in your book use fruit to add sweet flavors. Was this a way to limit refined sugar?

A.

Exactly. People always say to me, “What about fruit? It has sugar.” But I have nothing against fruit, because it comes with its inherent fiber, and fiber mitigates the negative effects. The way God made it, however much sugar is in a piece of fruit, there’s an equal amount of fiber to offset it.

There’s only one notable exception: grapes. Grapes are just little bags of sugar. They don’t have enough fiber for the amount of sugar that’s in them. But I have nothing against real food, and that includes real fruit. Eat all the fruit you want. It’s only when you turn it into juice that I have a problem with it, because then it loses its fiber.

Q.

You have two children at home. Do you let them eat sweets?

A.

So, first of all, my wife is Norwegian. She bakes for therapy. When she’s mad at me, she bakes. That’s how she gets her aggression out. But she only bakes once a week, and the kids only get fresh cookies. We never buy store-bought. Ever. And when my wife bakes five-dozen cookies, she gives them out to the rest of the block. We keep about a dozen cookies for ourselves and for the kids.

My wife has learned by experimenting that she can take any cookie recipe, any cake recipe, and reduce the amount of sugar by one third, and it actually tastes better, and it doesn’t ruin the texture. If you go down by a half, then it does. But if you go down by a third, the cookies still come out just as good. And you can taste the chocolate, the nuts, the oatmeal, the macadamia – whatever is in it. So it’s actually better, and the kids get it as a treat. On weekdays, when they want something sweet, it’s fruit. On the weekends, they’re allowed cookies. So we’re not militant. We’re toeing the line.

Q.

What is your favorite recipe in the new book, and why?

A.

Polenta patties with sautéed greens, poached eggs, Roma tomatoes and basil salsa. Hands down winner. It’s vegetables for breakfast. Even though it has carbohydrate, it’s unrefined. It’s high in fiber and micronutrients. It’s the highest quality protein: eggs. And it’s just downright amazing.

FOR THE POLENTA:
1 cup corn grits or cornmeal
4 cups water
Salt to taste

Bring water and salt to a boil in a large pot over high heat. Once the liquid is boiling, slowly add the grits or cornmeal, stirring constantly with a whisk to keep lumps from forming. When the grain is mixed smoothly into the liquid, reduce the heat to low and simmer gently for 30 minutes until very thick. Stir occasionally to keep the polenta from sticking. Allow to cool in an oiled 8-inch square pan or loaf pan.

Mix the tomatoes, garlic, basil, oil, balsamic vinegar, pepper and salt together in a bowl. The salsa is best when used immediately. Yield: 2 cups.

PREPARATION:

1. Remove the polenta from the pan and divide into six servings.

2. Heat 1 tablespoon olive oil in a large pan over medium-high heat. Add the polenta slices and fry until golden brown on both sides, about 3 minutes per side. Transfer the polenta slices to a plate and keep warm.

3. Add the remaining 1 tablespoon of oil to the pan and sauté the greens until wilted and tender.

4. Heat 2 inches of water just to a boil in a separate medium-size frying pan, add the white vinegar, then reduce the heat to low. Crack the eggs into the water and poach them until desired doneness, 2 to 3 minutes for soft yolks. Using a slotted spoon, remove the eggs from the water, being careful not to break the yolks. Transfer the eggs to a plate.

5. Place a polenta patty on each of six plates. Top each patty with greens and a poached egg. Pour salsa over all. Or, place all the polenta slices on a platter, top with greens, poached eggs and salsa.